Citation Nr: 0805068
Decision Date: 02/12/08 Archive Date: 02/20/08
DOCKET NO. 02-19 215 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Montgomery,
Alabama
THE ISSUE
Entitlement to an initial rating in excess of 10 percent for
arthralgia of the left wrist, status post fracture of
scaphoid.
REPRESENTATION
Appellant represented by: The American Legion
WITNESS AT HEARING ON APPEAL
Veteran
ATTORNEY FOR THE BOARD
Kristi L. Gunn, Associate Counsel
INTRODUCTION
The veteran served in the United States Army Reserves on
periods of active duty for training (ACDUTRA) from February
6, 2000 to February 26, 2000.
This case comes before the Board of Veterans' Appeals (Board)
on appeal from a June 2002 rating decision of the Montgomery,
Alabama, Department of Veterans Affairs (VA) Regional Office
(RO), which in pertinent part, granted service connection for
arthralgia of the left wrist, and assigned a noncompensable
evaluation effective May 14, 2001.
In a May 2006 Decision Review Officer (DRO) decision, the RO
increased the evaluation for the veteran's service-connected
arthralgia, left wrist; status post fracture of scaphoid to
10 percent, effective May 14, 2001. The veteran was advised
of the above grant of increased rating; however, she did not
withdraw her appeal. In AB v. Brown, 6 Vet. App. 35 (1993),
the United States Court of Appeals for Veterans Claims
(Court) held that, on a claim for an original or increased
rating, the veteran will generally be presumed to be seeking
the maximum benefit allowed by law and regulation, and it
follows that such a claim remains in controversy, even if
partially granted, where less than the maximum benefit
available is awarded. Thus, this appeal continues.
In April 2007, the veteran testified at a travel board
hearing before the undersigned Veterans Law Judge.
In August 2007, the Board remanded the claim for additional
development and adjudicative action. The case has been
returned to the Board for further appellate review.
The Board notes that the veteran waived initial RO
consideration of the new evidence submitted in conjunction
with her claim. 38 C.F.R. § 20.1304(c) (2007).
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of the veteran's appeal has been obtained.
2. The competent and probative evidence of record shows that
the veteran's service-connected arthralgia of the left wrist,
status post fracture of scaphoid, is manifested by slight
limitation of motion in the wrist, with subjective complaints
of continuing pain, numbness, tingling, and weakness, without
the presence of ankylosis.
CONCLUSION OF LAW
The criteria for an initial evaluation in excess of 10
percent for arthralgia of the left wrist, status post
fracture of scaphoid, have not been met. 38 U.S.C.A. §§
1155, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.159, 4.7,
4.40, 4.45, 4.71a, Diagnostic Code 5215 (2007).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
Decision
The veteran contends that her service-connected left wrist
disability is worse than the current evaluation contemplates.
During the April 2007 hearing, the veteran stated that she
has had soreness, excessive pain, and continuous numbing and
tingling of the left wrist since she tripped and fell over a
tent peg during her active duty for training. She testified
that she periodically takes Tylenol and receives steroid
shots to alleviate the pain, but the overall pain has
affected her well-being. The veteran explained that although
she is still employed as an environmental technician, her
symptoms have worsened and overall deteriorated.
Disability ratings are based upon schedular requirements that
reflect the average impairment of earning capacity occasioned
by the state of a disorder. 38 U.S.C.A. § 1155 (West 2002).
Separate rating codes identify the various disabilities. 38
C.F.R. Part 4 (2007). In determining the level of
impairment, the disability must be considered in the context
of the entire recorded history, including service medical
records. 38 C.F.R. § 4.2. An evaluation of the level of
disability present must also include consideration of the
functional impairment of the veteran's ability to engage in
ordinary activities, including employment. 38 C.F.R. § 4.10.
Also, where there is a question as to which of two
evaluations shall be applied, the higher evaluation will be
assigned if the disability picture more nearly approximates
the criteria required for that rating. Otherwise, the lower
rating will be assigned. 38 C.F.R. § 4.7.
Disability of the musculoskeletal system is primarily the
inability, due to damage or infection in the parts of the
system, to perform the normal working movements of the body
with normal excursion, strength, speed, coordination, and
endurance. It is essential that the examination on which
ratings are based adequately portray the anatomical damage
and the functional loss with respect to all of these
elements. In evaluating disabilities of the musculoskeletal
system, it is necessary to consider, along with the schedular
criteria, functional loss due to flare-ups of pain,
fatigability, incoordination, pain on movement, and weakness.
DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss
may be due to absence of part, or all, of the necessary
bones, joints and muscles, or associated innervation, or
other pathology and evidenced by visible behavior of the
claimant undertaking the motion. Weakness is as important as
limitation of motion, and a part that becomes painful on use
must be regarded as seriously disabled. 38 C.F.R. § 4.40.
Pain on movement, swelling, deformity or atrophy of disuse as
well as instability of station, disturbance of locomotion,
interference with sitting, standing and weight bearing are
relevant considerations for determination of joint
disabilities. 38 C.F.R. § 4.45.
The veteran is contesting the disability evaluations that was
assigned at the time service connection was granted for her
disability. This matter therefore is to be distinguished
from one in which a claim for an increased rating of a
disability has been filed after a grant of service
connection. The Court has observed that in the latter
instance, evidence of the present level of the disability is
of primary concern, Fenderson v. West, 12 Vet. App. 119, 126
(1999) (citing Francisco v. Brown, 7 Vet. App. 55 (1994)),
and that as to the original assignment of a disability
evaluation, VA must address all evidence that was of record
from the date the filing of the claim on which service
connection was granted (or from other applicable effective
date). See Fenderson, 12 Vet. App. at 126-27. Accordingly,
the evidence pertaining to an original evaluation might
require the issuance of separate, or "staged," evaluations
of the disability based on the facts shown to exist during
the separate periods of time. Id.
In this case, the veteran is presently receiving a 10 percent
evaluation for her service-connected left wrist disability
under Diagnostic Code 5215. Limitation of motion of the
wrist is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5215.
A 10 percent rating is warranted for limitation of motion of
the wrist (major or minor), such that dorsiflexion is less
than 15 degrees or palmar flexion is limited in line with the
forearm. That is the highest schedular disability rating
available under that Diagnostic Code. See 38 C.F.R. § 4.25
(2007).
For VA purposes, normal dorsiflexion of the wrist is from 0
to 70 degrees, and normal palmar flexion is from 0 to 80
degrees. Normal ulnar deviation of the wrist is from 0 to 45
degrees, and normal radial deviation is from 0 to 20 degrees.
Normal forearm pronation is from 0 to 80 degrees and normal
forearm supination is from 0 to 85 degrees. 38 C.F.R. §
4.71, Plate I (2007). The diagnostic codes pertaining to
impairment of the elbow, forearm, wrist, hand, and fingers
apply different disability ratings based upon whether the
major or minor arm is affected. 38 C.F.R. § 4.71a,
Diagnostic Codes 5213 through 5230.
When all the evidence is assembled, VA is responsible for
determining whether the evidence supports the claim or is in
relative equipoise, with the veteran prevailing in either
event, or whether a preponderance of the evidence is against
the claim, in which case, the claim is denied. Gilbert v.
Derwinski, 1 Vet. App. 49 (1990).
In May 2002, the veteran was afforded a pre-discharge
evaluation for her joints. During the examination, the
veteran informed the examiner that in February 2000, she fell
over a tent rope and fractured her left scaphoid bone and
suffered bilateral radial head fractures. She stated that
she has some periodic left wrist pain. Upon physical
examination of the veteran, the examiner noted normal range
of motion of all joints with no tenderness or swelling. X-
rays of the left wrist were normal. The relevant diagnosis
was arthralgia of the left wrist.
In September 2007, the veteran underwent a second VA
examination, specifically for her service-connected left
wrist disability. The veteran reported to the examiner that
she fell on her "outstretched hand" when she tripped over a
tent peg in February 2000. X-rays revealed a fracture of the
left carpal scaphoid and both radial heads. Her forearm was
splinted and a cast was worn until September 2000. After
attending occupational therapy for her left wrist, the
veteran stated that she still endures stiffness and flare-ups
of pain in the left wrist, which after repetitive use has
interfered with her employment activities as a nurse.
Physical examination of the veteran showed full pronation and
supination of the left forearm. Range of motion testing of
the left wrist revealed 30 degrees extension, 60 degrees
flexion, 30 degrees radial deviation, and 20 degrees ulnar
deviation. The examiner noted that the veteran was mildly
tender in the anatomical snuff box, but grip strength was
good. There was no enlargement of the first carpometacarpal
joint and range of motion in the first metacarpal was 30
degrees of flexion and 30 degrees of abduction. The examiner
indicated that there was no indication of a neurological
disorder, and there was no increased limitation of motion due
to weakness, fatigability, incoordination, or upon repetitive
use. X-rays revealed some flattening of the distal portion
of the scaphoid, suggestive of early, but definite
degenerative changes in the scaphoid trapezial junction. The
examiner diagnosed the veteran with a fractured scaphoid of
the left wrist and noted that the degenerative arthritic
changes in the area of the carpal scaphoid in the left wrist
appear to be secondary to the fracture she sustained in 2000.
Post service treatment records reflect continuing complaints
and treatment for the veteran's service-connected left wrist
disability. VA outpatient treatment notes dated April 2000
indicate that the veteran was in occupational therapy due to
status post bilateral radial fractures and a left scaphoid
fracture. The treatment note reports that the veteran was to
attend therapy three times a week for eight weeks, and was
restricted from lifting anything more than ten pounds, along
with no running, push-ups, or pull-ups. Follow-up treatment
in June 2000 noted that the veteran was four months status
post carpal scaphoid fracture, but thumb stiffness due to the
wrist problem was observed. Examination of the left wrist
revealed very minimal tenderness over the snuff area with
more tenderness over the distal first metacarpal near the
metacarpophalangeal joint dorsally. The veteran's range of
motion and first metacarpophalangeal joint were markedly
decreased. The physician diagnosed the veteran with radial
head fracture and left scaphoid fracture. The veteran was
again placed on therapy three times a week for a minimum of
eight weeks.
Private treatment records beginning in May 2002 reflect
treatment for an impacted fracture with volar angulation
after the veteran suffered a fall on her left upper
extremity. She was placed in a sugar tong splint with a
short arm cast thereafter. Follow-up treatment in June 2002
showed no change in the fracture, with x-rays revealing a
healed fracture in an acceptable position. In November 2002,
the veteran was seen again for complaints of pain in her left
wrist. The treatment note states that the veteran exhibited
some arthritis in the scaphoid and the trapezium of the
thumb. Her dorsiflexion was limited to 14 degrees and palmar
flexion to 8 degrees. The veteran demonstrated avascular
necrosis of the proximal pull of her scaphoid with
significant arthritis of the scaphoid trapezium joint and
definite loss of motion of her radial capitellar joint. In
January 2005, the veteran was seen again for complaints of
having difficulty with her left hand, pain in her wrist, and
diminution of her range of motion. Palmar flexion was 25
degrees, dorsiflexion was 20 degrees, and crepitus and
grinding were both present at the base of her thumb. There
was noted pain and paresthesias in a medial nerve
distribution with positive Tinel's on that side as well. X-
rays showed flattening of the scaphoid with arthrosis between
the scaphoid and trapezium. There was definite arthrosis at
the thumb carpal metacarpal (CMC) joint, and the wrist showed
shortening at the distal radius.
The Board notes that during the course of this appeal, the
veteran has received treatment for her service-connected left
wrist disability by Dr. D.T. Dr. T. states in a report that
the veteran has been a frequent patient under his care and
was initially seen in October 2001, with a history of
problems with her wrist. In the June 2002 letter, Dr. D.T.
explains that x-rays of her wrist at that time showed a
healed radial head fracture, a scaphoid fracture, and a
"little bit" of avascular necrosis of the proximal pole of
her scaphoid. Similarly, a November 2002 private medical
statement also reflects treatment due to residual pain and
arthritis of the left wrist joint. Dr. D.T. explained that
the veteran exhibited limited motion with dorsiflexion of the
wrist limited to 14 degrees, palmar flexion limited to 8
degrees, and axillary ulnar deviation and radial deviation
limited to approximately 10 degrees in each direction. X-
rays showed avascular necrosis of the proximal pull of her
scaphoid, and the physician opined that the veteran retired
from her job. In a follow-up letter dated January 2005, Dr.
D.T. reported that the veteran has continuing residual pain
and problems with her left wrist. Range of motion testing
revealed palmar flexion to 25 degrees, dorsiflexion to 20
degrees, ulnar deviation to 20 degrees, and radial deviation
to 15 degrees. The physician stated that the veteran
exhibits pain at the base of her thumb and at the anatomic
snuff box, which limits her ability to do heavy lifting and
strenuous work of significance. Finally, in December 2007,
Dr. D.T. stated that the veteran has continuing pain in her
wrist with tenderness at the scaphoid and some crepitus with
range of motion. She has approximately 30 degrees of
extension, 60 degrees of flexion, 30 degrees of radial
deviation, and 20 degrees of ulnar deviation. No significant
weakness or neurovascular compromise was exhibited, and Dr.
D.T. stated that the veteran's condition seemed "stable and
nonprogressive."
After consideration of all evidence of record, the Board
finds the preponderance of the evidence to be against a
disability rating in excess of 10 percent for the veteran's
service-connected left wrist disability. As noted above, the
veteran has already been awarded a disability rating of 10
percent for her disability, which is the maximum schedular
evaluation under Diagnostic Code 5215, for wrist
disabilities. Therefore, Diagnostic Code 5215 does not
assist her in obtaining a higher evaluation. The Board must
consider evaluation of the veteran's left wrist disability
under all other potentially appropriate diagnostic codes.
Under Diagnostic Code 5214 ankylosis of the wrist when in a
favorable position in 20 degrees to 30 degrees of
dorsiflexion warrants a 20 percent rating when affecting the
minor extremity, as here in this case (and 30 percent when
affecting the major extremity). With ankylosis in any other
position, except favorable, a 30 percent rating is warranted
when it affects the minor extremity (and a 40 percent rating
when it affects the major extremity). With unfavorable
ankylosis, in any degree of palmar flexion, or with ulnar or
radial deviation, a 40 percent rating is warranted when it
affects the minor extremity (and a 50 percent rating is
warranted when it affects the major extremity). In
evaluating the veteran's claim under Diagnostic Code 5214,
the Board notes that she has never been shown to have
ankylosis of the left wrist, which is immobility and
consolidation of a joint. See Dorland's Illustrated Medical
Dictionary 86 (28th ed., 1994). In this regard, the Board
notes the evidence consistently shows the veteran has
movement of the wrist in dorsiflexion (extension) and palmar
flexion, which clearly indicates she does not have ankylosis.
Therefore, while the veteran has consistently demonstrated
limited motion in dorsiflexion and palmar flexion, she does
not have ankylosis of the left wrist, and Diagnostic Code
5214 is not for application in this case.
The Board has also considered the veteran's service-connected
left wrist disability under Diagnostic Code 5003, for
degenerative arthritis. Degenerative arthritis established
by x-ray findings is rated according to limitation of motion
for the joint or joints involved. Where limitation of motion
is noncompensable, a rating of 10 percent is assigned for
each major joint (including the ankle and the knee) or group
of minor joints affected by limitation of motion to be
combined not added under Diagnostic Code 5003. Limitation of
motion must be objectively confirmed by findings such as
swelling, muscle spasm, or satisfactory evidence of painful
motion. In the absence of limitation of motion a 10 percent
rating is assigned where there is x-ray evidence of
involvement of two or more major joints, or two or more minor
joint groups; and a 20 percent evaluation is assigned where
there is x-ray evidence of involvement of two or more major
joints or two or more minor joint groups and occasional
incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic
Code 5003 (2007). While the veteran's left wrist has
demonstrated degenerative changes, the veteran's left wrist
disability is currently rated 10 percent disabling based on
limitation of motion. Therefore, Diagnostic Code 5003 does
not assist the veteran in obtaining a higher disability
evaluation.
The Board has also considered the veteran's left wrist
disability under 38 C.F.R. §§ 4.40 and 4.45 (2007) and the
decision in DeLuca, to determine whether she has any
additional limitation of motion due to pain, swelling,
weakness, or excess fatigability. The Board again notes the
veteran's continuing complaints of painful motion, swelling,
numbness, and tingling of her left wrist throughout the
pendency of this appeal. However, during the September 2007
VA examination, the examiner opined that the veteran's
limitation of motion was not increased due to weakness,
fatigability, incoordination, or repetitive use.
Furthermore, the RO explained in its May 2006 DRO decision
that the current 10 percent evaluation contemplates pain on
motion. Thus, the Board finds that any pain associated with
the veteran's service-connected left wrist disability is
encompassed in the 10 percent currently assigned to the
veteran's service-connected left wrist disability. See 38
C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, supra.
Consideration has also been given to the potential
application of the various provisions of 38 C.F.R. Parts 3
and 4, whether or not they were raised by the veteran. The
VA schedule of ratings will apply unless there are
exceptional or unusual factors which would render application
of the schedule impractical. See Fisher v. Principi, 4 Vet.
App. 57, 60 (1993). 38 C.F.R. § 3.321(b) (1) provides that
in exceptional circumstances, where the schedular evaluations
are found to be inadequate, the veteran may be awarded a
rating higher than that encompassed by the schedular
criteria. According to the regulation, an extraschedular
disability rating is warranted upon a finding that "the case
presents such an exceptional or unusual disability picture
with such related factors as marked interference with
employment or frequent periods of hospitalization that would
render impractical the application of the regular schedular
standards."
The veteran has not identified any specific factors which may
be considered to be exceptional or unusual in light of VA's
schedule of ratings; the Board has been similarly
unsuccessful in finding exceptional factors. Specifically,
the veteran has not required frequent periods of
hospitalization for her left wrist disability and there have
been no findings of exceptional limitation beyond that
contemplated by the schedule of ratings. The Board does not
doubt that limitation caused by her left wrist disability has
an adverse impact on employability; however, loss of
industrial capacity is the principal factor in assigning
schedular disability ratings. Consequently, the Board finds
that the 10 percent rating currently assigned adequately
reflects the clinically established impairment experienced by
the veteran and a higher evaluation is denied.
The Board notes that the veteran is appealing the initial
assignment of an evaluation following the grant of service
connection for arthralgia of the left wrist, status post
fracture of scaphoid, and that in such cases, the Board must
consider whether staged ratings should be assigned based upon
the facts found. Fenderson v. West, 12 Vet. App. 119 (1999).
In this case, there is no evidence that there have been
changes in the veteran's medical status regarding her left
wrist disability. Therefore, the veteran's overall
disability has not changed and a uniform rating is warranted.
In view of the foregoing, the Board finds that the evaluation
assigned adequately reflects the clinically established
impairment experienced by the veteran. As the preponderance
of the evidence is against the veteran's claim for an
increased rating for her service-connected arthralgia of the
left wrist, status post fracture of scaphoid, the benefit-of-
the-doubt doctrine is not for application, and an increased
rating must be denied. See Gilbert, 1 Vet. App. at 55.
II. Duty to Notify & Assist
The Veterans Claims Assistance Act of 2000 (VCAA) imposes
obligations on VA in terms of its duty to notify and assist
claimants. When VA receives a complete or substantially
complete application for benefits, it is required to notify
the claimant and the representative, if any, of any
information and medical or lay evidence that is necessary to
substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R.
§ 3.159(b) (2007); Quartuccio v. Principi, 16 Vet. App. 183
(2002). In Pelegrini v. Principi, 18 Vet. App. 112, 120-21
(2004), the Court held that VA must inform the claimant of
any information and evidence not of record (1) that is
necessary to substantiate the claim; (2) that VA will seek to
provide; and (3) that the claimant is expected to provide;
and that (4) VA will request that the claimant provide any
evidence in his or her possession that pertains to the claim.
For an increased-compensation claim, section § 5103(a)
requires, at a minimum, that the Secretary notify the
claimant that, to substantiate a claim, the claimant must
provide, or ask the Secretary to obtain, medical or lay
evidence demonstrating a worsening or increase in severity of
the disability and the effect that worsening has on the
claimant's employment and daily life. Vazquez-Flores v.
Peake, No. 05-0355, (U.S. Vet. App. January 30, 2008).
Further, if the diagnostic code under which the claimant is
rated contains criteria necessary for entitlement to a higher
disability rating that would not be satisfied by the claimant
demonstrating a noticeable worsening or increase in severity
of the disability and the effect that worsening has on the
claimant's employment and daily life (such as a specific
measurement or test result), the Secretary must provide at
least general notice of that requirement to the claimant.
Additionally, the claimant must be notified that, should an
increase in disability be found, a disability rating will be
determined by applying relevant diagnostic codes, which
typically provide for a range in severity of a particular
disability from noncompensable to as much as 100 percent
(depending on the disability involved), based on the nature
of the symptoms of the condition for which disability
compensation is being sought, their severity and duration,
and their impact upon employment and daily life. As with
proper notice for an initial disability rating and consistent
with the statutory and regulatory history, the notice must
also provide examples of the types of medical and lay
evidence that the claimant may submit (or ask the Secretary
to obtain) that are relevant to establishing entitlement to
increased compensation-e.g., competent lay statements
describing symptoms, medical and hospitalization records,
medical statements, employer statements, job application
rejections, and any other evidence showing an increase in the
disability or exceptional circumstances relating to the
disability. Vazquez-Flores, slip op. at 5-6.
Here, the duty to notify was not satisfied prior to the
initial unfavorable decision on the claim by the agency of
original jurisdiction (AOJ). Under such circumstances, VA's
duty to notify may not be "satisfied by various post-
decisional communications from which a claimant might have
been able to infer what evidence the VA found lacking in the
claimant's presentation." Rather, such notice errors may
instead be cured by issuance of a fully compliant notice,
followed by readjudication of the claim. See Mayfield v.
Nicholson, 444 F.3d 1328 (Fed. Cir. 2006) (where notice was
not provided prior to the AOJ's initial adjudication, this
timing problem can be cured by the Board remanding for the
issuance of a VCAA notice followed by readjudication of the
claim by the AOJ) see also Prickett v. Nicholson, 20 Vet.
App. 370, 376 (2006) (the issuance of a fully compliant VCAA
notification followed by readjudication of the claim, such as
a statement of the case (SOC) or supplemental statement of
the case (SSOC), is sufficient to cure a timing defect).
In this case, the VCAA duty to notify was satisfied
subsequent to the initial AOJ decision by way of two letters
sent to the veteran on November 2004 and August 2007 that
fully addressed all four notice elements. In the letter, the
veteran was informed that the evidence necessary to
substantiate the claim for an increased evaluation would be
evidence showing that her disability is worse than the
current evaluation contemplates. The letters also informed
the veteran that she must provide medical or lay evidence
demonstrating a worsening of her disability and the impact on
her employment and daily life, which can also be
substantiated by sending statements from other individuals
who are able to describe in what manner the disability has
become worse. It also informed her that on her behalf, VA
would make reasonable efforts to obtain records that were not
held by a federal agency, such as records from private
doctors and hospitals. The letters stated that she would
need to give VA enough information about the records so that
it could obtain them for her. Finally, she was told to
submit any evidence in her possession that pertained to the
claim.
Although the notice letters were not sent before the initial
AOJ decision in this matter, the Board finds that this error
was not prejudicial to the appellant because the actions
taken by VA after providing the notice have essentially cured
the error in the timing of notice. Not only has the veteran
been afforded a meaningful opportunity to participate
effectively in the processing of her claim and given ample
time to respond, but the AOJ also readjudicated the case by
way of May 2006 and October 2007 supplemental statement of
the cases after the notice was provided. For these reasons,
it is not prejudicial to the veteran for the Board to proceed
to finally decide this appeal as the timing error did not
affect the essential fairness of the adjudication.
In addition to the foregoing analysis, to whatever extent the
recent decision of the Court in Dingess v. Nicholson, 19 Vet.
App. 473 (2006), requires more extensive notice in claims for
compensation, e.g., as to potential downstream issues such as
disability rating and effective date, the Board finds no
prejudice to the veteran in proceeding with the present
decision. Since the claim is being denied, any such
effective date questions are moot. The veteran has had ample
opportunities to meaningfully participate in the adjudicative
claims process. Any error or deficiency in this regard is
harmless, and not prejudicial.
VA must also make reasonable efforts to assist the claimant
in obtaining evidence necessary to substantiate the claim for
the benefit sought, unless no reasonable possibility exists
that such assistance would aid in substantiating the claim.
38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. In connection with
the current appeal, VA obtained the veteran's service medical
records, private medical records dated March 1993 to December
2007, and VA outpatient treatment records from April 2000 to
June 2000. The veteran was also provided a VA examination in
connection with her claim.
For the foregoing reasons, the Board concludes that all
reasonable efforts were made by VA to obtain evidence
necessary to substantiate the claim. The evidence of record
provides sufficient information to adequately evaluate the
claim. Therefore, no further assistance to the veteran with
the development of evidence is required, nor is there notice
delay or deficiency resulting in any prejudice to the
veteran. 38 U.S.C.A. § 5103A(a)(2); 38 C.F.R. § 3.159(d);
see Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on
other grounds, 444 F.3d 1328 (Fed. Cir. 2006).
ORDER
Entitlement to an initial rating in excess of 10 percent for
arthralgia of the left wrist, status post fracture of
scaphoid is denied.
____________________________________________
C. CRAWFORD
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs